Surgical teams at The Johns Hopkins Hospital,
Barnes-Jewish Hospital in St. Louis and Integris Baptist
Medical Center in Oklahoma City on Feb. 14 successfully
completed the first six-way, multihospital, domino kidney
transplant.

All six donors (one man and five women) and six organ
recipients (four men and two women) were in good condition
following the surgery, according to Robert Montgomery,
chief transplant surgeon at Johns Hopkins.

The procedure, called kidney paired donation or KPD,
takes a group of incompatible donor- recipient pairs
(recipients with a willing donor who is not compatible by
blood or tissue) and matches them with other pairs in a
similar predicament. By exchanging kidneys between the
pairs, each recipient receives a compatible kidney from a
stranger, and transplants are enabled that otherwise would
not have taken place. Involving multiple hospitals creates
even more possibilities for matches.

In this so-called domino swap, a surgical team made up
of nine surgeons, six anesthesiologists and 12 nurses began
a cross-country set of operations with five incompatible
pairs; an altruistic donor and a recipient who was next on
the United Network for Organ Sharing recipient list started
and ended the domino. (Altruistic donors are those willing
to donate a kidney to any needy recipient.)

Just like falling dominoes, the altruistic donor
kidney went to a recipient from one of the incompatible
pairs, that recipient's donor's kidney went to a recipient
from a second pair and so on. The last remaining kidney
from the final incompatible pair went to the UNOS
recipient.

As part of this complex procedure, Johns Hopkins flew
one kidney to Integris Baptist; Integris Baptist flew one
to Barnes-Jewish, and Barnes-Jewish flew one to Johns
Hopkins.

"We have performed a six-way domino procedure at our
hospital before," Montgomery said. "But this is the first
time we have done something this ambitious on such a grand
scale involving two other hospitals. This will serve as a
blueprint for national matches in which kidneys will be
transported around the country, resulting in an estimated
1,500 additional transplants each year."

The 12 surgeries — all of which had to start at
the same time — began at 7 a.m. EST. The surgeons in
charge included four at Johns Hopkins, three at Integris
Baptist and two at Barnes- Jewish. All finished by 7 p.m.
EST.

Johns Hopkins surgeons performed one of the first KPD
transplants in the United States, in 2001; the first
triple-swap, in 2003; the first double and triple domino
transplants, in 2005; the first five-way domino transplant,
in 2006; and the first six-way domino transplant, in 2007.
Johns Hopkins also performed the first multihospital,
transcontinental three-way swap transplant, in 2007.

The other surgeons who participated in the surgery
were Mohamad Allaf, Andrew Singer and Dorry Segev of Johns
Hopkins; Scott Samara, Shea Samara and William Miller of
Integris Baptist Medical Center; and Surendra Shenoy and
Martin Jendrisak of Barnes-Jewish Hospital.